J Cardiol 2007 May; 49（5）: 217 – 219

Important Message
Remarkable Efficacy of Thermal Therapy for Sjögren Syndrome
Chuwa

TEI, MD, FJCC

Koji

ORIHARA, MDTsuyoshi

FUKUDOME, MD

Key Words■ Thermal therapy■ Heart failure（infrared-ray dry sauna）■ Cardiomyopathies, dilated■ Cells（monocytes）■ Complications（Sjögren syndrome）■ Leukocytes（human leukocyte antigen-A, B, C）

We previously provided repeated thermal therapy
using an infrared-ray dry sauna evenly maintained
at 60°C for patients with chronic heart failure andreported that it improved the hemodynamics andsymptoms.1 − 4）Furthermore, we previously showedin vivo that the advantageous effect is based in parton the up-regulation of the endothelial nitric oxide
synthase（ eNOS）expression level after repeatedthermal therapy.5,6）In this report, we describe apatient who suffered from Sjögren syndrome withcomplications of idiopathic dilated cardiomyopathy（DCM）, and we demonstrate that repeated therapy
using an infrared-ray dry sauna remarkably
improved the symptoms of Sjögren syndrome aswell as DCM. In addition, we simultaneously
observed that this therapy down-regulated theabnormally high level of human leukocyte antigen（HLA）-A, B, C（major histocompatibility complex
class I）
expression on the monocytes to close to thenormal range, regardless of the fact that the medications were left unchanged during the sauna therapy.
A 62-year-old female had been experiencing
arthritic pain and dry mouth since April 2001 ; she
was diagnosed to have Sjögren syndrome and had

been taking the appropriate medication.
Subsequently, she developed the subjective symptom of shortness of breath on effort in 2002, wasdiagnosed with DCM, and medical follow-up treatment was initiated. She was admitted to our hospital in March 2004. On admission, xerostomia,xerophthalmia and arthritis from Sjögren syndrome
were particularly noticable. The severity of cardiac
failure was New York Heart Association（NYHA）
class Ⅱ−Ⅲ, and the white blood count, C-reactive
protein and brain natriuretic peptide（BNP）levels
were 4,900 /μl, 1.05 mg/dl and 118 pg/ml, respectively. Other notable findings were that the antiRNP antibody and anti-Sm antibody were positive,and the anti-DNA antibody was 3 IU/ml. The antiSSA and anti-SSB antibodies were negative.
Ultrasonic cardiography showed the left ventriculardiastolic volume（LVDV）, left ventricular systolicvolume（LVSV）and ejection fraction（EF）
were 150ml, 111 ml and 26%, respectively.
After 20 times of repeated thermal therapy once
each day for 4 weeks, cardiac dysfunction
improved（LVDV ＝ 106 ml, LVSV ＝ 67 ml, EF ＝37%, BNP ＝ 40 pg/ml, NYHA classⅠ−Ⅱ）. Inaddition, the subjective symptoms of Sjögren syn-──────────────────────────────────────────────
鹿児島大学大学院医歯学総合研究科 循環器・呼吸器・代謝内科学〔鄭 忠和，折原弘治，福留 剛〕 : 〒 890−8520 鹿児島
県鹿児島市桜ヶ丘 8−35−1
Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima
Address for correspondence : TEI C, MD, FJCC, Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate Schoolof Medicine, Kagoshima University, Sakuragaoka 8−35−1, Kagoshima, Kagoshima 890−8520 ; E-mail : tei@m.kufm.kagoshimau.ac.jp
Manuscript received March 5, 2007 ; accepted March 27, 2007217

218

Tei, Orihara, Fukudome

AB

CD

200

Cell count

150
100
5000

1101001,0000110100

1,000

HLA−A，B，C MFIFig. 1 Alleviation of xerostomia and normalization of the HLA-A, B, C expression level on the monocytes
A : Xerostomia before thermal therapy.
B : Alleviation just after thermal therapy.
C : HLA-A, B, C expression level on the monocytes is represented numerically with values derived frommean fluorescence intensity（MFI）treated with anti-HLA-A, B, C antibody（black line）divided by control MFItreated with anti-IgG2a（gray zone）. The mean ± SD was 3.37 ± 1.31
（n ＝ 23）.
D : HLA-A, B, C expression level is shown as the red line
（11.60）, and the modulation after 20 sessions ofthermal therapy shown as the blue line（6.34）.

drome, in particular, xerostomia and arthritis, wereall dramatically alleviated（Figs. 1−A, B）. On theother hand, we examined the HLA-A, B, C expression level on the circulating monocytes, which activated the CD8 ＋ cytotoxic T lymphocytes7,8）andare capable of inhibiting the cytotoxic activity ofthe NK cells,9）by flow-cytometry before and after
the 20 sessions of repeated thermal therapy. The
results showed that she had an HLA-A, B, C
expression level which was 3.4 times higher thanthe mean value of the normal volunteers（n ＝ 23）
before the thermal therapy, but after the thermal
therapy, the level was down-regulated and evenapproached the normal range（mean±2SD, n＝23 ;Figs. 1−C, D）. We hypothesized that this modulation of HLA-A, B, C on the monocytes may thus beassociated with the alleviation of the symptoms ofSjögren syndrome, and our study investigating thismechanism is now currently in progress.
This case shows that thermal therapy may qualify as a treatment for Sjögren syndrome.
Furthermore, repeated thermal therapy was foundto effectively alleviate the symptoms of three consecutive patients with Sjögren syndrome, in particular the symptoms of xerostomia and arthritis,without any complications.

J Cardiol 2007 May; 49（5）: 217– 219

Thermal Therapy and Sjögren Syndrome

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